A Summary of Plan Options and Services

The chart that follows is intended to help you compare Fee-for-Service (or Indemnity), HMO and PPO plans as well as POS features. Plans will vary. Please consult specific policy descriptions for details on the plans or policies you are considering.

Plan Type Claim Forms Financial Structure Preventive Care Providers
Fee for Service
(or Indemnity)
Patient files claim forms
(Physician or other Provider may file as a courtesy.)
Deductible probable; co-pay on percentage basis Not generally covered Patient (member) can use any physician or facility; may require pre-approval process*
HMO No claim forms No deductible when service in network; typically low, pre-set co-payment Emphasized: checkups, immunizations and early detection screenings covered Usually use plan-approved providers accessed through a gatekeeper* (a primary care HMO physician)
PPO No claim forms usuallySimilar structure to HMO when service in network Preventive care may not be covered; screenings are covered under some plans Gatekeeper usually not required; can elect out-of-network provider usually at higher cost
Note: Adding a POS feature to a health plan
Claim forms may be required In network, similar to HMO; out-of-network services may be higher in cost Usually covered: checkups, immunizations and early detection screenings No gatekeeper required; can elect out-of-network provider with pre-approval*
* except emergencies

Updated on: 3/8/2019